Cervical Cancer
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What is cervical cancer?
Cervical cancer means cancer of uterine cervix, the part of uterus that continues in to vagina (birth canal) below.
How common the cervical cancer is?
Cervical cancer is second most common cancer, after breast cancer in Indian women. Every year about 1.3 lakhs women are diagnosed and about 74,000 women die of disease in our country.
What are common risk factors for cervical cancer?
Cervical cancer is not hereditary, so, if a mother had cervical cancer, her daughter is not at higher risk for the same.
It usually presents in reproductive age group between 40 to 55yeras of age.
All cervical cancer cases are preceded by stage of pre-invasive lesion of cervix (caused by Human Papilloma Virus infection) that last for about 10 years, and are easily identifiable (with Pap smear cytology test) and are 100% treatable lesions.
Some common risk factors to acquire HPV infection:
- Sexual activity before age of 18 years, either by you or your partner.
- Sex with multiple partners.
- Personal history of sexually transmitted infection, either by Herpes or bu HPV.
- Immuno-compromised state such as on long term steroids or history of renal transplantation or if HIV positive.
- History of Smoking.
- Long term users of oral contraceptives (>15 years).
What are common risk factors for cervical cancer?
Pre-invasive lesions of cervix and very early cervical cancer may not cause any symptoms. So, it becomes very important to attend regular cervical cancer screening with pap cytology test or HPV DNA Test or both for early detection as cancer can be cured 100% in early stages.
However, some of the common symptoms of cervical cancer are:
- Irregular vaginal bleeding
- Contact bleeding or spotting
- Increased bleeding during menses
- Post-menopausal bleeding (bleeding after menopause)
- Foul smelling vaginal discharge
- Pain and swelling in one or both the legs (indicate advanced stage)
In case you have any of above mentioned symptoms, you should contact specialist on a priority basis.
In case you have any of above mentioned symptoms, you should contact specialist on a priority basis.
Regular cervical screening with Pap smear test plus HPV DNA Teat is the best way to prevent cervical cancer as they pick up any abnormal cell changes, which can be easily treated before they develop into cervical cancer.
- HPV vaccination: HPV vaccination (both Gardasil and Cervrix) has the potential to prevent pre-invasive lesions of cervix and cervical cancer as it provides immunity against HPV virus. A target population of 9-14 years of girls has been recommended by FOGSI Gynaecologic oncology committee for 2 doses of HPV vaccination at 0 and 6 months apart. For catch up vaccination of 15-26 years of girls, 3 dose schedules have been recommended at 0, 1 and 6 months.
- Note: Cervical cancer screening has to be continued even after HPV vaccination as vaccine covers only 70% of cervical cancer causing HPV viruses.
- Pap smear Cytology: Pap smear involves taking cells from surface of cervix with help of a spatula and to study them under microscope to look for abnormal changes. It’s a simple and painless test to be done in OPD in less than two minutes, however, it has a great potential to detect early changes in the cervix. Women with abnormal Pap smear test are referred for colposcopy and biopsy.
- Note: A simple Pap test has caused 70% reduction in mortality from cervical cancer in western world.
- HPV DNA: Human Papilloma virus is the main causative organism for pre-invasive lesions on cervix that ultimately progress to cancer over period of time. Not all HPV types cause cancer. Some are responsible for benign conditions such as skin warts over perineum or papillomas over larynx. The one causes cancer are called as High risk HPV types (HR-HPV). Thus, detection of HR-HPV infection from cervix with the help of HPV-DNA test points towards possibility of pre-invasive lesion on cervix.
How the diagnosis of cervical cancer confirmed?
Women with abnormal results on cervical screening or with symptoms as mentioned above will be taken up for examination:
On examination, if a lesion/ulcer is present on cervix, a biopsy will be taken to confirm the diagnosis.
In the absence of any visible lesion on cervix, colposcopic directed biopsy will be done. Colposcopy involves examining the cervix under a microscope (a colposcope) and application of a solution that can turn any suspicious lesion white, thus, will able to take biopsy.
Then the biopsy specimen will be studied under microscope to look for presence of cancerous cells.
How to decide the stage of cancer?
Cervical cancer is one cancer where stage is determined before surgery.
Once the diagnosis of cervical cancer is confirmed on biopsy, additional tests are done to know about how much cancer has spread to neighbouring as well as distant organs (called as staging):
- Vaginal examination under anaesthesia (EUA): This involves examination of vagina, cervix, parametrium, bladder and rectum to know about tumor size as well to know whether cancer has spread to nearby organs. This takes about 5 minutes but needs to be done in OT under anaesthesia as complete muscular relaxation is required. EUA is a very important part of work up to decide whether a woman is a candidate for surgery or not.
- Chest X-ray
- CECT Scan (Abdomen and pelvis)
- CE-MRI (Abdomen and pelvis)
- PET-CECT
- Blood Investigations
All these tests are required to know whether the cancer has spread to other organs. Not all tests are required for every woman. The combinations of tests are decided based upon type of cancer ns the women’s profile.
What are the treatment options for cervical cancer?
Depending upon the stage, Women are grouped into early stage and locally advanced stage cervical cancer.
For early stage, surgery is the main treatment followed by radiation if required.
For Locally advanced cervical cancer, Radiation therapy along with chemotherapy is the treatment.
Cervical cancer is a readily preventable cancer as it takes a long time for pre-invasive lesion of cervix to progress to cancer. Regular cervical screening with HPV DNA along with Pap test is the best way for prevention.